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Section 1 - Applicant Information

Organisation or Individual Name *

Legal Status

Registration Number

Phone Number *

Email Address

Address

Town

Postcode

Main Contact

Name *

Job Title *

Phone Number *

Email Address

Section 2 - Project Summary

An overview of the proposed initiative

Project Title *

Brief Description *0 / 150

Project Goals *0 / 100

Target Population *0 / 100

Geographic Location *

Section 3 - Impact

Which group of people will you be mainly be working with? *

What outcomes do you hope to achieve *

How many people will benefit? *

Section 4 - Budget

Please provide a full breakdown of all costs

Costs Breakdown

Please provide a full breakdown of all costs, which may include

Staffing
Purchase of equipment
Hire of lease of premises
Transport costs
Promotion of project
Consumables
Refreshments or food.

Costs

Description *

Amount *

GBP

Total

£

Section 5 - Bank Details

Bank Name

Account Name

Sort Code

Account Number

Account IBAN

SignatoriesPlease provide the names of the signatories on the bank account

First Name

Surname

Trustees or DirectorsPlease provide the names and contact details of all the Trustees or Directors

Name *

Phone Number *

Email Address *

Address

Town

Postcode

Supporting Documents

Copy of Constitution

No file chosen

Bank StatementPlease note the statement should be dated within the last 3 months

No file chosen

Declaration

BY SUBMITTING THIS FORM YOU ARE DECLARING

You will spend all of your grant, deliver support to your clients, and return your monitoring and receipts by ???????

You have adequate and appropriate insurance in place at all times which covers all activities within the funded project, including any assets you have purchased or leased, and employee and public liability.

You will ensure that you do not discriminate in any way on the grounds of age, disability, gender or gender identity, race, religion and sexual orientation and avoid committing any act of unlawful discrimination, harassment or victimisation prohibited by the Equality Act 2010; this is fully described in the attached notes.

You shall maintain appropriate procedures to require your members, trustees and employees to declare any potential or actual conflicts of interest in any matter concerning your activities which are funded by any grant we might supply.

You will be aware of and comply with employment law, which covers pension rules, payroll, the minimum wage, and health and safety.

If you work with children, young people or vulnerable adults, you will:

Take all reasonable steps to ensure their safety
Have and implement an appropriate written policy and set of procedures in place to safeguard vulnerable people
Undertake DBS (Disclosure and Barring Service) checks necessary on all those
Individuals who are required by law or best practice have them.

I, hereby declare that the information provided in this application for funds is true, accurate, and complete to the best of my knowledge and belief.

I understand that any misrepresentation or omission of facts in this application may result in the disqualification of our application or the forfeiture of any awarded funds.

I also understand that if awarded, the funds will be used solely for the purposes outlined in the application and in accordance with the guidelines and regulations set forth by the granting organisation.

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CONTACT US

DEWSBURY EAST COMMUNITY TRUST BOUNDARY